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Haiti has long had difficulty supplying clean drinking water to its more than 9.7 million inhabitants, a situation compounded by last year's devastating earthquake and more recently by a cholera outbreak that has claimed more than 3,800 lives since October. Whereas the most promising short-term solution to this problem has been treating household water—often collected from bacteria-infested rivers, streams and wells—with chlorine, the logistics of delivering disinfectants and monitoring their use in a country largely devoid of transportation infrastructure has greatly hindered progress.

As a result, aid workers often have difficulty reaching families in rural Haiti to ensure they have enough microbe-killing chlorine and are using it properly. Without regular visits—every month or so—rural Haitians typically revert to drinking unclean water, which helps spread cholera and other diarrheal infections.

Only about 4 percent of Haitians living in rural areas have water piped into their homes, says Michael Ritter, national program officer and CEO of Deep Springs International (DSI), a nonprofit based in Léogâne, not far from the epicenter of the January 2010 quake that killed about 220,000 people. "That means people leave the home to get their water and bring it home," he adds. Travel times vary from region to region, but more than one third of rural Haitians travel more than 30 minutes to obtain water. Even in more urban areas such as the capital city of Port-au-Prince, only 21 percent of Haitians have a household water connection.

Ritter and his DSI colleagues have seen the problem firsthand, which is why they are teaming with Nokia Corp. and the University of California, Berkeley, School of Public Health to create a mobile data-gathering platform they hope to begin rolling out by the end of the month. As part of the project, DSI community health workers will affix radio-frequency identification tags (RFID) to the 19-liter buckets they provide Haitian families to store their drinking water. These workers will then use mobile phones equipped with near-field communication (NFC) capabilities to read the tags (confirming that a particular bucket assigned to a particular family has been visited) and then relay information about the water's condition via short message service (SMS) texts to a database back at DSI's headquarters.

The goal is for DSI to be able to reach more than the 35,000 families they currently serve throughout Haiti. Given DSI's limited funding and personnel, more accurate tracking of which families need careful monitoring (as opposed to those that are inherently more diligent in cleaning their water) is expected to help the organization better allocate its resources.

The number-one factor that has determined the success of DSI's clean water program to date is how often health workers visit households. "If a family had received a visit, they treated their water," Ritter says. "If a family was not visited, it was 50–50 as to whether they treated their water."

Coming clean
DSI and other aid organizations in Haiti focus on treating water at the home rather than at the source because, even if the water sources could be decontaminated, there is a risk of recontamination as the water is brought back to the home. DSI has been delivering water treatment systems (which essentially consist of a covered 19-liter bucket with a spigot at the bottom) and a locally manufactured chlorine solution it has labeled Gadyen Dlo (Creole for "water guardian") since 2007. Gadyen Dlo is a 0.7 percent sodium hypochlorite liquid solution used to treat drinking water. It takes 30 minutes for one seven-milliliter capful of solution to kill enough microbes in 19 liters of water for that water to be potable. "It's simple, it works and it's cheap," Ritter says.

A 240-milliliter bottle of Gadyen Dlo costs about $1.25 and can last as long as two months, depending on household size. DSI health workers use a pool-testing kit to analyze the chlorine level of a five-milliliter sample of drinking water—if less than the recommended amount of Gadyen Dlo is present, the water may not be safe to drink.

Tech solution
Now DSI is working with the Nokia Research Center (NRC) in Palo Alto, Calif., and U.C. Berkeley's School of Public Health to put as many as 50 Nokia 6212 mobile phones in the hands of DSI health workers as part of a pilot project. The hope is that DSI will be able to document visits more quickly and accurately than it can with its current paper-based system. Under the current system, most DSI health workers fill out forms that may take several days to reach the organization's main office.

Nokia chose the 6212 model, which debuted in 2008, specifically for this project because it is equipped with NFC technology but also because it is does not have a fancy touch-screen interface and is less likely to be stolen from DSI workers. "The security situation in Haiti, is not good," says Joseph "Jofish" Kaye, a senior research scientist and ethnographer at NRC. "The 6212 also has good battery life, going a week or more without needing to be recharged."

Knowing that the phones would need the right software to function properly, Kaye reached out to School of Public Health PhD student David Holstius, to whom he had been referred by a mutual friend. Kaye laid out the Haiti project to Holstius, who is researching low-cost sensing and mobile applications in the school's Environmental Health Sciences Division. Any software that Holstius wrote needed to function on the 6212, be straightforward to use and be inexpensive for DSI to manage moving forward.

Holstius chose an open-source messaging program called FrontlineSMS to manage text-messaged data sent by DSI workers from the field. He had heard of other aid organizations using successfully using FrontlineSMS to organize communications in Haiti following the earthquake, and he knew he could turn to the software's open-source community of users for support when needed.

For the cell phone itself, Holstius wrote an application that prompts the worker to scan a bucket's RFID tag; asks questions including, "Did the water test positive for chlorine?" and "How much chlorine did you sell [to the household]?"; records the results; and sends those results to DSI's back-end computers. "I also had to make sure the SMS would be queued in the phone's memory if there was no access to the network," he says. "Initially, Nokia's phones would drop SMS messages to be sent to DSI if the phones could not connect to the network. I had to write my own outbox."

When placed within four centimeters of an NFC tag, the Nokia 6212 device recognizes the signal and launches the application Holstius wrote. DSI tested a prototype messaging system last year that proved the system could work successfully despite the intermittent reliability of Haiti's utility and mobile phone networks.

Looking ahead
Once in the hands of health workers, the mobile phones are expected to provide DSI with rapid feedback in a way that will help the organization identify families that need more intensive follow-up and allocate resources accordingly. "We're hoping that by incorporating cell phones we'll be able to better target the work that the health workers are doing and actually see greater adoption of the water-cleaning system," Ritter says. The automated system will also serve as a check on DSI health workers, ensuring they are in fact visiting families, given that they will be unable to complete their assignments without scanning bucket tags.

Kaye, who learned of DSI's challenges accurately collecting timely data in December 2009 while he was looking for potential projects to fund, initially secured $10,000 (including cash and 50 cell phones) from Nokia Research Center to assist DSI. More recently Nokia has provided an additional $24,500 to expand the project beyond its initial pilot phase. Kaye is hoping by next week to decide whether to stick with the 6212 handset as the project grows or to provide DSI with the newer C7 NFC-equipped handset, which has a touch screen. As the program progresses, Nokia will also have to decide whether to contribute some of its own more sophisticated data-management software to the applications that Holstius is writing.

Meanwhile, Haiti's Direction Nationale de l'Eau Potable et de l'Assainissement (DINEPA), the government's water and sanitation authority, has said that household water chlorination is a big part of its plan to combat cholera, Ritter says, adding that he wants DSI's work to be integrated with the government's efforts. "The cell phone project plays into that in that we're always looking for ways to optimize what we're doing," he says. "Right now, it's a matter of training the supervisors to take the initial phones out in the field. Ultimately, we want to get cell phones in the hands of all of the health workers distributing Gadyen Dlo."